Objective To study the anesthesia effect of propofol and sevoflurane in the operation of elderly patients,analyze the advantages and disadvantages of two anesthesia drugs,and explore the best anesthesia method for elderly patients.Methods 60 elderly patients treated in our hospital from September 2013 to September 2015 were selected,and randomly and equally divided into two groups.Sevoflurane group underwent induced anesthesia of sevoflurane and injection of remifentanil,propofol group underwent continuous injection of remifentanil and injection of propofol.HR,MAP,and the blood gas analysis (pH,PO2,PCO2) were compared between two groups before surgery (T0),10 rain after the beginning (T1),30 min after the beginning (T2),30 min before the end (T3),10 min before the end (T4).The postoperative recovery was observed.Results HR and MAP at T2 and T3 were lower than those at T1 in two groups,HR and MAP at T2 in sevoflurane group were (73.89+7.13) times/min,(80.69+9.43) mmHg,those at T3 were (72.11+6.25) times/min,(80.14+8.91) mmHg,HR and MAP at T2 in propofol group were (66.24+7.24) times/min,(68.71+ 10.18) mmHg,those at T3 were (63.47+6.45) times/min,(67.13+11.35) mmHg,HR and MAP at T2 and T3 in propofol group were lower than those in sevoflurane group,with statistically significant differences between two groups (P＜0.05).PO2 at T2 and T3 in sevoflurane group were (247.51+71.47),(268.15+68.46)mmHg,those in propofol group were (189.17+73.32),(183.14+67.17) mmHg,PO2 at T2 and T3 were higher than that at T1 in two groups (P＜0.05),those in sevoflurane group were even higher (P＜0.05).The recovery time of swallowing reflex,awakening time,and extubation time in propofol group were (10.4+2.5)min,(20.5+7.2)min,(35.8+8.6)min,those in sevoflumne group were (6.2+1.9)min,(12.8+3.8)min,(24.6+6.1)min,those in sevoflurane group were significantly shorter than those in propofol group (P＜0.05).Observer's Assessment of Alertness/sedation (OAA/S) score when waking up in propofol group was (4.2±0.4),that in sevoflurane group was (4.1+0.7),without statistically significant difference between two groups (P＞0.05).Conclusion For elderly patients,the combined anesthesia of sevoflurane has better effect compared with propofol.During the operation,patients' vital signs are more stable,the awakening time greatly shortens,worthy of clinical promotion.%目的 探讨丙泊酚和七氟烷应用于老年患者手术的麻醉效果,分析两种麻醉药物的优劣势以寻求最适用于老年患者的麻醉方式.方法 选择2013年9月至2015年9月期间在本院行手术治疗的60例老年患者,按照随机原则平均分为两组,分别是七氟烷组和丙泊酚组,其中七氟烷组预充七氟烷诱导麻醉和复合泵注瑞芬太尼,丙泊酚组则是持续输注瑞芬太尼,并复合输注丙泊酚,对比两组在手术前(Tn)、手术开始10 min(T1)、手术开始30 min(T2)、手术结束前30 min(T3)、手术结束前10min(T4)的心率(HR)、平均动脉压(MAP)、血气分析中(pH、P02、PCO2)水平,并观察两组患者在术后的苏醒情况.结果 两组患者在T2、T3两个时间段的HR和MAP的两项指标和手术前10 min相比有明显的下降,七氟烷组T2时HR和MAP为(73.89±7.13)次/min、(80.69±9.43) mmHg,T3时为(72.11±6.25)次/min、(80.14±8.91) mmHg,丙泊酚组T2时HR和MAP为(66.24±7.24)次/min、(68.71±10.18)mmHg,T3时为(63.47±6.45)次/min、(67.13±11.35) mmHg,两组比较差异有统计学意义(P＜0.05),且在T2、T3两个时间段丙泊酚组相较于七氟烷组HR和MAP下降程度更大,差异有统计学意义(P＜0.05);此外,七氟烷组PO2T2时为(247.51±71.47) mmHg、T3为(268.15±68.46)mmHg,丙泊酚组T2时为(189.17±73.32) mmHg,T3为(183.14±67.17) mmHg,两组患者在T2、T3时间段PO2水平也较T1时间段均有明显的升高(P＜0.05),并且以七氟烷组患者升高的趋势更明显(P＜0.05);丙泊酚组术后吞咽反射恢复时间、术后清醒时间、拔管时间分别为(10.4±2.5) min、(20.5±7.2)min、(35.8±8.6)min,七氟烷组上述指标分别为(6.2±1.9) min、(12.8±3.8) min、(24.6±6.1) min,七氟烷组患者术后吞咽反射恢复时间、术后清醒时间、拔管时间均明显短于丙泊酚组(P＜0.05);苏醒时警觉与镇静评分(OAA/S)丙泊酚组为(4.2±0.4),七氟烷组为(4.1±0.7),两组比较差异无统计学意义(P＞0.05).结论 对于老年手术患者,七氟烷复合麻醉方式相比丙泊酚更具优势,不仅在手术过程中提供更稳定的生命体征,同时能够显著缩短术后苏醒时间,值得临床推广.
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